Individual provider Active NPI

Kelly Kriklava, P.A.

  • Physician Assistant
  • Cincinnati, OH
National Provider Identifier
1487193132
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.007959RX Issued in OH
Practice address
3333 Burnet Ave, ML 1013
Cincinnati, OH 45229
Phone
(513) 636-4466
Fax
(513) 636-5846
NPI assigned
Feb 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0006386 MD
Physician Assistant 363A00000X PA9111155 FL
Surgical Physician Assistant 363AS0400X 4542 TN
Physician Assistant 363A00000X 50.007959RX OH Primary

Addresses

Primary practice location

3333 Burnet Ave, ML 1013
Cincinnati, OH 45229

Mailing address

PO Box 417
Stuart, FL 34995-0417
Phone (772) 781-2799

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkriklava55871@direct.martinhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260508003275 GA Practitioner - Physician Assistant 6507124872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4542TNMDPhysical Therapy Assistant
C0006386MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Martin Memorial Physician Corporation Inc PastSince Apr 1, 2004 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1487193132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349950417",
            "telephone_number": "772-781-2799",
            "fax_number": "772-781-2716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE, ML 1013",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45229",
            "telephone_number": "513-636-4466",
            "fax_number": "513-636-5846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRIKLAVA",
        "first_name": "KELLY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-14",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0006386",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111155",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "4542",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007959RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkriklava55871@direct.martinhealth.org",
            "affiliation": "N",
            "address_1": "3801 S Kanner Hwy Ste 200",
            "city": "Stuart",
            "state": "FL",
            "country_code": "US",
            "postal_code": "349944801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.